Euthanasia
Gonzalo Herranz, department Bioethics, University of Navarra
Lecture given at the Istituto Libero Universitario
Campus , Rome, 1997
Text derived from a class outline class medical ethics taught in Pamplona.
1. Ethical texts relating to end-of-life care
2. instructions for end-of-life care
a. Respect for and protection of weakness
b. The finite nature of aggressive interventions
3. Professional refutation of euthanasia
4. The need to closely monitor the Dutch case
perennial topic : one that we will have to discuss throughout our lives.
In the media, in illustrated and professional magazines, in books—on knowledge dissemination study—on medicine, Philosophy law, there is constant talk of euthanasia, of financial aid for suicide. Much less is said about the quiet care provided in hospitals and palliative care centers, in the homes of terminally ill patients, and in hospices for human life in its final stages. Journalists are drawn to dramatic cases, provocative sociological surveys, and the opinions of the enfants terribles of contemporary ethics.
A permanent confrontation awaits us: on the street, in the hospital, in our own souls. Pro-right-to-die-with-dignity groups, manifestos of liberation from pain, exaltation of the right to final self-determination: to dispose of one's own life. Pro-life groups, pro-palliative care groups.
This is topic it is not enough to simply take sides: we must seek reasons. meeting : this is where the most decisive battle will be fought, one that will define the future of the health professions: whether medicine should continue to be a service to all people, including the incurable and the dying, whether the Hippocratic tradition of utmost respect for life should continue to prevail; or whether, on the contrary, the medical profession should serve the strong against the weak, becoming an instrument of social Darwinism.
Before getting into subject, it is worth taking a look at the status .
The status can be summarized as follows:
Arguments in favor of euthanasia and financial aid in suicide
There is widespread but intense pressure in favor of legalizing financial aid in suicide and euthanasia. Very active groups, using tactics to sway public opinion, dramatic cases, and waves of discussion on radio and TV. Opinion polls reveal that the majority of the population (around 75%) is in favor of euthanasia. Insistence that opposition to euthanasia has no rational basis, but is religiously motivated.
Legislative developments B: The Netherlands, Australia's Northern Territory, and Oregon already have laws authorizing euthanasia and financial aid in suicide. At the legislative level, there is a widespread trend toward softening the penalties for mercy killing. Spain, for example.
A very persuasive argument that bases its arguments in favor of euthanasia and physician-assisted suicide on the principles of autonomy and beneficence, so deeply rooted in contemporary bioethics. It is a layered argument that puts opponents on the defensive. It goes something like this:
First stratum. This patient suffers unbearably. He is determined to die, he wants to die, because his life is negative and degrading for him. He is competent to decide, to consent.
Therefore, it is ethical, compassionate, merciful, and beneficial to end his life through euthanasia or to assist him in committing suicide.
Second layer. Not helping someone die is evil; it is leaving unanswered a request—autonomous, rational, and humane—for a dignified death. It is like abandoning a human being at the moment when they need us most, which is especially serious in the case of doctors, since doctors are the experts in managing the resources that can make death painless and easy.
Third stratum. It is not only cruel, but immoral, for a doctor to refuse to respond to a patient's request for death. It is unfair that euthanasia is not a general moral obligation, including not only those who request it, but also those who are unable to request it. Not helping someone who is unconscious to die is discriminatory: it is punishing and depriving someone who is unable to request it of a right: an unjust act of violence.
When the patient cannot ask for death, it is a moral obligation to end their miserable life by providing non-voluntary or involuntary euthanasia. The Dutch Pediatric Society has based its rules on euthanasia for children and newborns with a poor quality of life on this argument.
A few more arguments:
The poorly treated pain. Pro-euthanasia activists occasionally reproach doctors for not knowing how to treat pain properly. But that is not solved by euthanasia, but by studying pharmacology. The patient dies at the hands of a doctor who kills him and who is also incompetent.
Sociological surveys. Activists add that 77% and 60% of those surveyed are in favor of euthanasia.
Cryptanasia and medical hypocrisy. Others say that euthanasia (cryptanasia) is performed frequently and that it is time for doctors to stop being hypocrites.
With the problem posed in this way, let's look for the answers. We will look for them in three places:
1. Ethical texts relating to end-of-life care.
2. instructions for end-of-life care.
3. Professional refutation of euthanasia
1. Ethical texts relating to end-of-life care
In reality, there should not be a specific code of ethics for terminal patients. They are just like any other patient.
Italy. Code of Medical Ethics, 1995.
Oath: Aware of the importance and solemnity of the act I am performing and the commitment I am undertaking, I swear: never to perform acts that deliberately cause the death of a patient; to adhere in my work to the ethical principles of human solidarity, against which, out of respect for life and the person, I will never use my knowledge.
In Chapter V, Care for the dying. Art. 35. Even if requested by the patient, the physician must not perform treatments aimed at impairing mental and physical integrity and shortening life or causing death. Art. 36. In the case of diseases with a definitely unfavorable prognosis and which have reached the terminal stage, the physician may limit his or her work, if such is the specific wish of the patient, to moral assistance and therapy aimed at sparing unnecessary suffering, providing appropriate treatment and preserving the quality of life as far as possible.
The Code does nothing more than transcribe the practically universal rule
The WMA three times:
a) Geneva: requires that all patients application treated with the same care and application without discrimination.
b) Venice on terminal illness, which states that it is the duty of the physician to cure and alleviate suffering as far as possible, always keeping in mind the interests of their patients; that they will not admit any exceptions to this principle, even in cases of incurable disease or malformation; that this principle does not prevent the following rules from being applied: 3.1. The physician may alleviate the suffering of a terminally ill patient by suspending curative treatment with the patient's consent or, if the patient is unable to express his or her own will, with the consent of the patient's family, but such suspension of treatment does not release the physician from his or her duty to attend dying patient and to provide the necessary medication to alleviate the terminal phase of the illness. And, finally, the physician shall refrain from using any extraordinary means that will not benefit the patient.
c) Madrid on Euthanasia, which establishes that euthanasia, that is, the deliberate act of ending a patient's life, even at their own request or at the request of their relatives, is contrary to ethics. This does not prevent the physician from respecting the patient's wish to allow the natural process of dying to take its course in the terminal phase of their illness.
BMA. AMA, lecture on Medical Orders. For example: BMA: "The law should not be changed. Deliberately killing a human being must remain a crime. This rejection of any change to the current law, so that doctors would be allowed to intervene to end a person's life, (...) is, above all, an affirmation of the supreme value of the individual, regardless of how worthless or hopeless they may feel."
Codes of ethics echo this moral doctrine: they define the conduct of healthcare professionals toward the terminally ill by the duties not to discriminate against them and to care for them with application. They may not cause their death, but they must refrain from treating them aggressively with futile therapies. They will never disparage the lives of their patients, but they will learn to respect life by accepting the inevitability of death.
There are therefore positive professional duties: to alleviate physical and moral suffering, to maintain as far as possible the quality of declining life, to be guardians of the dignity of every human being and the respect due to him or her, to ensure that palliative care is not marginalised by the scientific advances that come from biomedical experimentation.
And there are also negative professional duties: euthanasia and therapeutic gestures lacking in reasonableness and good judgement, which seek a cure that is already impossible and which may be established out of ignorance, for commercial interests, or for political reasons, are strictly forbidden. These are the basic texts of palliative deontology, on which doctors and nurses should often reflect.
The ethical richness of end-of-life medicine:
- the constant assessment of the validity of the care provided;
- the stratification of care for the terminally ill into palliative and terminal measures;
- extending the benefit of specific palliative care to all potential candidates for receiving it;
- optimising the cost/benefit ratio of palliative care
- teach the science and general art of palliative care.
- specialization program terminal medicine.
2. instructions for end-of-life care
Palliative care rests, in my view, on two basic pillars of medical ethics. One is the ethical respect for weakness, which must be accepted and protected as part of human existence. The other is the limited, finite nature of aggressive medical interventions, which must give way to palliative care as a wise and compassionate response to terminal illness. These are worth considering in detail.
a. Respect for and protection of weakness
Palliative care is applied to terminally ill, terminally ill patients. Sometimes, their ruin is predominantly physical and characterised by uncontrollable progression of organ failure. At other times, the most salient feature is the deterioration of relational life, dementia, persistent vegetative state. The doctor and the nurse know that they can no longer recover these lives and restore them to health. How are they to cope in such situations?
Some doctors and nurses, however, believe that there are lives so lacking in quality and dignity that they are not worthy of medical care or human comfort. Such an attitude represents not only a complete subversion of the ethical tradition of the healthcare professions and of Western culture as a whole, but also a betrayal of the future.
The reason is clear: one of the most fruitful and positive elements in the progress of both medicine and society has been the understanding that the weak are important. It was precisely from this idea that civilization and medicine were born. But despite almost two millennia of Judeo-Christian cultural influence, respect and service to the weak continue to encounter resistance within each of us and within society. Today, the rejection of weakness is being accepted and exercised on an unprecedented scale.
In the Christian ethical tradition degree scroll being weak was degree scroll for earning respect and protection. Today, for people with a libertarian and individualistic mindset, weakness is a stigma that marks one for programmed destruction. And to achieve this, they seek to change the aims of medicine. Medicine, they tell us, can no longer have the sole purpose of curing the sick or, at least, alleviating their suffering and comforting them. The doctor's office or hospital wards must function as repair shops: either they fix more or less satisfactorily the damage that illness causes to the body and soul of man, or they assign those condemned to live a precarious and terminal existence to the scrap heap. Medicine thus becomes an instrument of social engineering, a tool the new enlightened and aristocratic mentality of well-being and high quality of life.
As doctors and nurses, we need to understand that our first ethical duty, respect for life, usually takes on a special, specific form: ours is a respect for weakened life. In all our relationships with our patients, respect for life is almost always linked to the acceptance of the essential vulnerability and fragility of human beings and, often, to the recognition of the inevitability of death, of something that cannot be fought against. We do not have to deal with healthy and strong people, but with sick and weak people, with human beings who are experiencing the crisis of losing their physical vigor, their Schools , their lives. The ethical respect of doctors and nurses who administer palliative care is respect for suffering, declining life; their work of caring for people in the Degree of weakness.
Faced with the terminally ill patient, a riddle must be solved: that of discovering and recognising in the terminally ill patient all the dignity of a human being. Terminal illness tends to eclipse dignity: it hides it and even destroys it. If health gives us, in a certain way, the capacity to reach a certain human fulfilment, being ill means, in a thousand different ways, a limitation of the capacity to develop the project of man that each one of us cherishes. A serious, incapacitating, painful illness, which diminishes our humanity, especially a terminal illness, does not consist only of molecular or cellular disorders. Nor can we reduce it to an experiential journey through the phases that mark the patient's reactions to ineluctable death. Above all, the terminal status constitutes a threat to the integrity staff, which puts the sick person as a human being at test .
Doctors and nurses should not forget this when caring for our patients. Our attendance be reduced to a simple technical-scientific operation. It always includes an interpersonal dimension: it is not only about avoiding pain and alleviating the symptoms that arise from damaged biological Structures functions, but also about removing the threat of loneliness and helplessness, and communicating peace and human warmth.
Res sacra miser. This Christian-Stoic expression, revived by Vogelsanger, magnificently expresses the special status the sick person's humanity in the tense environment of terminal illness. It perfectly conveys the coexistence of the sacred and dignified nature of all human life with the misery caused by illness. When the sick person is viewed in this light, as something both dignified and miserable, we can recognize their condition as both inviolable and needy. This is, in my opinion, the ethical foundation of palliative care.
The hedonistic mentality, intolerant of suffering and disability, as well as the evolutionary philosophies of biological and social survival of the fittest, or the practice of competitive struggle for power and opportunity, and, finally, the emphasis on Economics production-consumption Economics , carry within themselves the seeds of contempt for the sick, the weak, and the unproductive. Many today believe that euthanasia is the most coherent response to the issue of the elderly, many of whom are paradoxical victims of medical progress, avid but inefficient consumers of finite healthcare resources, as they believe that money should not be spent on terminally ill and irrecoverable patients, for whom facilitating death is an ethical and economic alternative as valid as respect for life. We are now very close to making Nietzschean ethics official: care and compassion for the weak and insignificant are characteristic of a slave morality, of a decadent humanity impoverished in its instincts. The ethics of will, strength, and power prevail.
And yet, the ethical tradition of medicine tells us that medical respect for the patient must be proportionate to the patient's weakness: the terminally ill patient has a privileged right to the doctor's attention, time, capacity, and skills, as there is an obligation to treat each person as they are, without discriminating against them for being who they are.
We all need to frequently review our attitude toward the ethical principle of non-discrimination. I usually give my students a test, developed by Paul E. Ruskin, so that they can honestly analyze whether their commitment to non-discrimination is solid.
Ruskin once asked nurses participating in a course on "Psychosocial Aspects of Old Age" to describe honestly how they would feel if they had to attend cases such as the one he described below: This is a patient who appears to be her chronological age. She does not communicate verbally, nor does she understand spoken language. She babbles incoherently for hours and seems disoriented in terms of her person, space, and time, although she seems to recognize her own name. She is not interested in or cooperative with her own hygiene. She must be fed soft foods, as she has no teeth. She is incontinent of feces and urine, so she must be changed and bathed often. She drools continuously and her clothes are always stained. She is unable to walk. Her patron saint is erratic; she wakes up frequently during the night and her cries wake others. Although she seems calm and friendly most of the time, several times a day, for no apparent reason, she becomes very agitated and has unmotivated crying fits.
The response that students usually give is generally negative. Caring for a patient like this would be devastating, a waste of doctors' and nurses' time, some say. The most motivated point out that a case like this is a test tough test of the patience and vocation of the doctor or nurse. Of course, if all patients were like the one described, the specialization program would be for saintly doctors and nurses, but not for ordinary ones. When told that these responses are not only incompatible with the ethic of non-discrimination but also grossly exaggerated and unfair to reality, the comments are usually ones of disdain or rejection. test ends by circulating among the students a photograph of the patient in question: a beautiful six-month-old baby. Once the audience's protests about feeling victimized by a hoax have subsided, it is time to consider whether the solemn and self-gratifying commitment to non-discrimination can yield to differences in weight, age, life expectancy, or the subjective feelings inspired by the physical appearance of different patients, or whether, on the contrary, it must overcome these data . It is obvious that many students and professionals need to change their overly sensory, sentimental way of viewing their patients. They must convince themselves that the elderly patient is, as a human being, as dignified and kind as the little girl. Patients who are living out the last days of their lives, and those incapacitated by senility and dementia, deserve the same care and attention as those who are beginning their lives in the incapacity of early childhood.
Let us now turn to consider the second pillar on which the arc of palliative care rests:
b. The finite nature of aggressive interventions
It is essential for doctors and nurses to recognise the practical and ethical limits of our power. It is not enough for us to know that we are, in fact, neither technically all-powerful nor can we fix everything. We must be aware that there are ethical limits that we must not overstep, because our actions would be not only futile but also harmful. Two things are necessary for this: the first is to have a precise idea that, despite their aggressiveness and efficacy, there comes a time when our resources and actions are inoperative, inevitably finite; the second is to understand that neither therapeutic obstinacy nor the patient's withdrawal are ethical responses to terminal status : palliative care is.
Work is now actively underway to define, in clinical protocols and ethical terms, the notion of medical futility. There is diagnostic futility, just as there is therapeutic futility. This establishes the possibility of diagnostic cruelty, just as there is therapeutic cruelty. The line between proper palliative care and the error of excessive zeal is unclear in many clinical situations. Nor do we know exactly how effective many new interventions are. There will always be a more or less wide margin of uncertainty, in which it will be necessary to decide in the face of indeterminacy and lean toward offering the patient the benefit of the doubt. But doctors and nurses will always have in work , inevitably, there will come a point when the gains from their interventions will be disproportionately small in relation to the suffering they cause or the expense they entail.
In order not to lose their ethical orientation, their sense of relevance and depth, throughout the course of their relationship with the terminally ill person, the physician and nurse providing palliative care must see their patient with a binocular vision. They must maintain an awareness of the fundamental fact that they are dealing with a human being: that their relationship with the patient is one of person to person, whose aspirations, wishes and convictions must be taken into account and fulfilled as far as is reasonable. This relationship staff must also extend to those close to the patient. They must see this with their human-sensitive retina and staff of their patient.
But at the same time, doctors and nurses have to attend to the needs and limits of the terminal patient's precarious biology, of the life that is ebbing away. With their scientific eye, they must see beneath the skin of the terminally ill patient a seriously disturbed biological entity. The patient can never be reduced to a mere collection of disarranged molecules or bewildered organs, or to a chaotic and ruined pathophysiological system. But he is these things and, at the same time, a human being. The doctor's binocular vision must integrate, superimpose, the image of this pathophysiological system damaged beyond repair, with that of this human being who cannot be abandoned, who must be respected and cared for until the end.
Therein lies the greatness and the risk of palliative care. Seeing the person simultaneously, in order to continue ahead of them, and seeing the collapse of their biology simultaneously, in order to refrain from taking futile measures. Doctors and nurses always need this dual vision, as required by their dual role as caregivers and cultivators of natural science. The assessment of biochemical parameters and the monitoring of vital signs symbolize that goal element goal the doctor-patient relationship, which, by its very nature, requires the maximum possible detachment from any emotional or affective bond. One cannot be a good healthcare professional if, in that scientific, objectifying moment, compassion and empathy are not set aside in order to calculate objectively and equitably what the appropriate terms of intervention should be.
Scientific indicators indicate at a certain point that the pathophysiological imbalance is now irreversible, that the terminal phase of the disease has begun, with no turning back. The idea of a cure must then be abandoned in favor of the highly official document of science, skill humanity: palliative care. The act of recognizing that there is nothing more that can be done to cure the patient can be difficult, but it is a clear and profound manifestation of humanity, a highly ethical, truthful, and application action. It can be a very difficult situation for the patient and their family to accept, putting test trust in doctors and nurses to test . The patient may then feel the need for a second opinion, and they should never be prevented from calling in a competent colleague.
People are increasingly coming to understand that their trust in their caregivers can no longer be based primarily on whether doctors and nurses indulge them with their easygoing and indulgent sympathy, but rather on their scientific objectivity, on the reliability of their knowledge, on their technical skill , on their familiarity with accepted methods of diagnosis and treatment, on their tempered Withdrawal to the futile, and, where appropriate, on their mastery of palliative care.
3. Professional refutation of euthanasia
Pro-euthanasia activism is gaining followers among doctors and nurses. Judging by certain sociological surveys, there is a sector among health professionals that accepts the idea that it is justified, and even virtuous or morally obligatory, to end certain human lives that lack quality. And some of them are willing to do so, either by administering euthanasia drugs or by withholding nutrition and fluids. If they do not do so, it is because of the legal risks they may incur.
Whoever has succumbed to the temptation of sweet death and performed euthanasia, either repents definitively, or will no longer be able to stop killing. Because if he is ethically congruent with himself, and believes that he is doing something good, he will do it in less and less dramatic cases and, in the name of ethics, by skirting legal barriers. For if the law, as seems likely in the first generation of euthanasia laws, only authorises euthanasia or financial aid to suicide for those who ask for it freely and voluntarily, what reasons can be given by those who have practised it according to the law to deny it to those who are incapable of asking for it, but whose life is more degraded or much more burdensome for others? He is certain that the insane person, the person sleeping in an irreversible coma, the victim in a chronic vegetative state, would undoubtedly ask for it if they had a moment of lucidity. Once euthanasia is authorised, the virtues of the doctor are turned against him. No matter how careful he is of his patients' autonomy, no matter how much he respects their capacity to choose, if he thinks that there are lives so lacking in quality that they do not deserve to be lived, he will conclude that sometimes there is only one thing left to choose: the death of the extremely weak. If a doctor or a nurse were to consider euthanasia as a superior remedy to palliative care, they could not help but become subjective mandators of terminally ill patients. Faced with a patient who is unable to express his or her will, they reason thus in their hearts: "It is horrible to live in such precarious biological or psychological conditions. I wouldn't want to live like that. That is not life. It is better to die. Therefore, I decide that the best thing for them is a sweet death". But the utilitarian judges that there are cases in which the desire of certain patients to go on living may be irrational and capricious, because they have an abhorrent prospect ahead of them. He reasons thus: the lives of certain patients capable of making decisions are so lacking in quality that they are not worth living. To insist on living them is an unjust desire, which entails an irrational consumption of resources, economic and human: that money and that work effort could be much better spent. It is very easy to expropriate the patient's freedom to choose to go on living.
With each passing day, I am convinced that palliative care contains an ethic of great density: it is in itself a dimension of Medicine and Nursing that cultivates and enriches the most intimate and basic ethical values. It is also the antidote that can protect us against the temptation of euthanasia, which is both frightening and attractive.
A highly effective antidote. Even the most upright doctor and nurse need to guard against the excesses of their virtues. To decriminalise euthanasia would be to plunge medicine into the self-aggressive disease of counterfeit compassion. The obligation to respect and care for all human life is a wonderful and inspiring moral force. With it, we must develop the theory and the internship of palliative, scientific and humane care, which will uproot from our hospitals the scandalous error of therapeutic overkill and which will highlight, by contrast, the cold inhumanity which, disguised as compassion, is hidden in euthanasia.
If nurses and doctors worked in an environment where they knew they would go unpunished whether they treated or killed certain patients, they would become indifferent to certain types of patients, and research vast areas of pathology would wither away. Because if the first option for senile patients or those suffering from Alzheimer's disease is euthanasia, who would be motivated to study the causes and mechanisms of brain aging or the constellation of factors that determine dementia? If patients with advanced cancer are offered assisted suicide as a valid therapy for their disease, who will be interested in the mechanisms of metastatic spread or the metabolic disorders induced by cachexia mediators? All the mental and moral effort, the sometimes exhausting tension of fulfilling the Hippocratic precept of seeking the good of the patient—"I will do everything I know and can for the benefit of the sick, and I will strive not to harm or do injustice to them"—would suffer, in a society tolerant of euthanasia, from atrophy through disuse.
The scientific values of medicine suffer an impoverishment when part of them are absorbed into euthanasia. And humanity also suffers, as it is expropriated from death, because euthanasia, if it became widespread, would become the final solution to the unfathomable mystery of death. Death would no longer be staff, but a simple routine technical gesture, executed neatly.
Let us consider for a moment what would happen if euthanasia became, either through social tolerance or permissive legislation, a medical act that was not punishable by law, with the consequent annulment of professional ethical jurisdiction. Let us imagine this in two situations: in the hospital and in the patient's home.
I believe that the effects on the ethical environment of the hospital would be catastrophic, because hospitals, and especially teaching hospitals, are the places where acceptable and effective medical interventions are primarily created, tested, and confirmed. The level of medical care in society depends on the scientific and ethical climate that prevails in hospitals. Hospital doctors serve as model the rest of the profession. Their behavior is contagious, for better or for worse. The future of medicine would be quite bleak if hospitals taught young doctors and nurses, medical and nursing students, that curing or killing are two legitimate aspects of their future professional activity. The morale of doctors, their ability to fight for the health and lives of their patients, would be irreparably weakened if doctors accepted that killing certain patients is simply one of several acceptable forms of therapy. If euthanasia became a treatment for certain diseases or situations, doctors, out of compassion or convenience, out of exhaustion or to get rid of a hateful patient, or because of the hustle and bustle of hospital life and simply to survive, to reduce the excess work somewhat, or to free up a bed needed for a patient with a very interesting disease, might be tempted to eliminate those who had the least chance of survival, or who took up more of their time, or who frayed their nerves the most. Euthanasia would leave future generations of doctors heartless.
In the patient's home, the consequences of decriminalizing euthanasia would be no less catastrophic for medicine. The term cryptanasia has been coined to describe hidden euthanasia, which is practiced by doctors secretly or clandestinely, sometimes in collusion with the patient's family, or at the request of the patient themselves. This may seem like a sinister and exaggerated scenario. Unfortunately, cryptanasia is a real phenomenon that threatens family medicine. Criminal tolerance of homicide due to illness would certainly damage people's faith in general practitioners and hospitals as places of hope and healing. If doctors were authorized by law to kill, public confidence in medicine as an institution dedicated exclusively and wholeheartedly to healing and caring for the sick would collapse, either suddenly or through a slow process.
Proponents of the legalization of euthanasia insist that it is possible to draft laws with sufficient safeguards and penalties to prevent potential abuses. Above all, they insist that it should be reserved for those who consciously and repeatedly request it, or those who have expressed their wishes in a legally valid living will. But this is a vain hope. Once euthanasia for medical reasons has been established as a right or a legitimate request for patients who seriously and expressly request it, a slow drift toward involuntary euthanasia is inevitable. Singer and Siegler have described four ways in which the acceptance of financial aid suicide or voluntary euthanasia inexorably leads to involuntary euthanasia. These paths are cryptanasia, euthanasia encouraged by socioeconomic factors (as in the case of the demented and elderly in populations with demographic imbalances), delegated euthanasia (ordered by the closest family member), and discriminatory euthanasia (for minorities rejected by the majority society).
Granting that legal safeguards and controls could, for some time, contain the expansive spread of permissive behavior, their collapse over time is inevitable. Permissive laws internship capacity internship repress the punishable forms of the crimes they decriminalize. Similar to what happens in the case of abortion—there is no legal barrier to illegal abortion as long as the administrative appearances of legality are maintained—there will be no legal barrier to any homicide if the motive of compassion is invoked.
As an English doctor once said, with a touch of macabre humor, no matter how carefully drafted a law may be by parliament, allowing euthanasia in the strictest and most defined terms possible, it will inevitably end up undergoing a process of erosion, of progressive relaxation. Let us suppose that this law allowed euthanasia to be applied only to those who, after full deliberation, could sign a application . After a few months, someone might say: "Look at these patients: poor elderly people who are paralyzed, incontinent, brain-dead. If someone could grant them five minutes of lucidity, with the certainty of immediately falling back into their permanent coma, wouldn't they rush to sign the application ? Of course they would. Why not allow their relatives to do it for them?" Suppose this reasonable request were accepted in the internship: after a month, someone would say, "Asking family members to make that decision is imposing a heavy burden on them. What is the point of making them feel guilty? We have no right to place that emotional burden on their shoulders. Why not put that decision in the hands of a well-trained judicial officer or a doctor?"
All this may seem like a tale of dark humor, a pessimistic calculation of an improbable and sinister future. But it is, in large part, a reality.
This brings us to the final point of my lecture:
4. The need to closely monitor the Dutch case
The answer to the question of where legal tolerance of euthanasia leads is becoming clear in what has been happening in the Netherlands for the past few years. The answer is clear: this tolerance leads to an unexpected brutalization of medicine.
It is not easy to summarize the legal, sociological, religious, and ethical-medical aspects that have contributed to the phenomenon of euthanasia in the Netherlands, which currently makes it a unique case among the nations of the world. In fact, as result long-standing social conditioning, Dutch society has largely accepted that voluntary euthanasia is acceptable and that it is a plausible manifestation of individual freedom. But that same society also largely accepts involuntary euthanasia and the denial of life-saving care when applied to terminally ill patients, individuals with severe disabilities, the elderly, or certain patients without families. In view of this state of opinion, the government and the justice system in the Netherlands have de facto accepted the internship euthanasia. They have not changed the Penal Code, which continues to punish euthanasia with up to 12 years in prison. But they have modified the regulations governing burials: a certificate indicating that the cause of death was euthanasia is reviewed by the medical examiner, who discreetly checks whether the euthanasia guidelines of the Royal Dutch Medical Association have been followed. Doctors have thus become experts in matters of life and death.
In fact, since 1984, and in the face of guaranteed judicial impunity, the machinery for the euthanasia of disabled lives has been set in motion. There are no official and reliable figures on its incidence in the Netherlands.
report on euthanasia and other medical decisions concerning the termination of life.
When the data are read carefully, the following conclusions can be drawn: Euthanasia, defined strictly as the act of intentionally ending a person's life by someone other than the patient, but at the patient's request, was voluntarily declared in 2,300 cases. issue 400 cases issue financial aid suicide, in which the doctor provided the patient who requested it with sufficient medication to carry it out. Life-ending treatment was applied in 1,000 cases where euthanasia had not been explicitly or repeatedly requested. There were therefore 3,700 cases in which doctors prescribed, provided, or administered medication with the deliberate intention of ending life, accounting for 2.9% of all deaths.
But the report also revealed that there were 5,800 cases in which, at the patient's request, treatment was suspended or not initiated, and 82%, or 4,756 patients, died. Of the nearly 25,000 cases in which treatment was not started or was suspended without the patient's request, in 8,750 cases, or 35%, the purpose was purpose end life. Of the total of 22,500 patients who died from a morphine overdose, 8,100 patients, or 36%, were administered the drug with the intention of ending their lives. Thus, it can be concluded from the data report that in practically 20% of the 129,000 deaths that occurred in the Netherlands in 1990, that is, in 25,306 cases, death was due to medical decisions regarding the end of life. If we exclude from that total of 129,000 the 43,300 cases of rapid death (accidents, sudden or unexpected death) in which medical decisions regarding the end of life are practically inapplicable, it turns out that those decisions played a more or less decisive role in 30% of cases of death preceded by illness treated by a doctor.
There is another striking aspect of report . Only 4% of the doctors surveyed stated that they would never perform euthanasia on one of their patients and would never ask a colleague to do so. Eight percent said they would never do it themselves, but would refer the case to another colleague who was not reluctant to perform it. Those who said they had never done it but would be willing to do so under certain conditions accounted for 34%. Finally, 54% had performed euthanasia.
The Netherlands is clearly a special country, where continuous environmental pressure has been exerted on the elderly to make them aware that it is selfish to want to live when they are a burden on society and that, consequently, they should plan their own euthanasia in advance, as this is the courageous, wise, and progressive behavior expected of a rational and altruistic person. As they die, there are some weak signs of rebellion against this status . The elderly living in nursing homes are overwhelmingly (93 percent) opposed to active euthanasia, which is approved by 76 percent of the general population. And although there are many more who carry their living will, theircard credit card credit a sweet death," the issue those who provide themselves with a "declaration of desire to live and be treated medically in case of illness or accident" is growing, especially among the elderly.
The status poses an imminent danger of human impoverishment in internship . Euthanasia undermines the trust that must govern the doctor/patient relationship, an essential part of which is the conviction that the doctor must never abandon his patient or deliberately inflict any harm on him. Giving the doctor discretionary power over the lives of certain people, many of whom are defenseless, represents a breach of that fundamental trust. In the Netherlands, there is a growing issue patients who develop attitudes of fear, suspicion, or mistrust toward doctors, who refrain from going to the doctor's office or being admitted to the hospital, or who refuse to take prescribed medications. For them, medicine is no longer a beneficial and trustworthy profession. They now see it as a real and imminent danger.
An alarming collection of anecdotes about medical brutalization induced by social and professional acceptance of euthanasia can be found in Richard article "A Case against Dutch Euthanasia," published in the Hastings Center Report, the Spanish translation of which has been reproduced, with the permission of Atlántida magazine, in the December 1991 and January-February 1992 issues of the OMC magazine of committee of Medical Associations. It makes for chilling and enlightening reading.
I must conclude. The scientific values of medicine suffer an impoverishment when part of them are absorbed into euthanasia. And humanity suffers too. Under the ceremonial soft music, tears, and tender gestures of farewell with which the administration of euthanasia is sometimes ritualized, a cynical and cruel operation is hidden: the expropriation of death. Euthanasia, if it were to become widespread, would become the final solution to the unfathomable mystery of death. The end of man would no longer be staff drama. There can be no mourning for those who have been subjected to murder by illness. A society that adopts euthanasia—and all deaths, except sudden ones, are susceptible to design will not only subject death to its control, but will also program it by assigning it a mode, place, and time. Death will no longer be staff, but a simple technical gesture, executed neatly, without fuss. But the euthanasia control of death will expropriate man of his freedom. Man will no longer die a natural death: he will be executed.
Thank you very much.